Objective ·To investigate the imaging features of computed tomography (CT) and magnetic resonance imaging (MRI) in the patients with Kimura disease (KD) in the head and neck. Methods ·Sixty-four cases of KD in the head and neck comfirmed by histopathology were retrospectively collected from 2009 to 2023 in Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine. All patients completed CT and/or MRI enhancement imaging before surgery. Clinical and imaging characteristics were collected, recorded and analyzed, including age, gender, peripheral blood eosinophilic ratio, serum IgE level, the lesion location, shape, size, CT density and degree of enhancement, MRI signal intensity and degree of enhancement, apparent diffusion coefficient (ADC), time-signal intensity curve (TIC) patterns, wash-in rate, and time to peak (TTP). Results ·The average age of the 64 KD patients was (40±19) years, and 92.2% were males. A total of 73.5% of the patients showed an elevated ratio of peripheral blood eosinophil, and all 10 tested patients exhibited increased serum IgE levels. There were 82 extranodal (subcutaneous and glandular) lesions and 144 lymph node lesions detected by CT and MRI. Among the extranodal lesions, 80.5% were subcutaneous or glandular patchy lesions with unclear boundaries, and the rest were nodular lesions with clear boundaries. All lesions exhibited isodensity on CT scans and showed isointensity on T1-weighted imaging (T1WI) and hyperintensity on T2-weighted imaging (T2WI) in MRI. Most extranodal lesions tended to show heterogeneous enhancement, while most lymph node lesions showed homogeneous enhancement. The median ADCs of the extranodal lesions and the lymph node lesions were 1.04×10 ^-3 mm ²/s and 0.67×10 ^-3 mm ²/s, respectively, which were significantly different ( P=0.000). The dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) results showed that the TIC patterns of extranodal lesions were predominantly type Ⅰ and Ⅱ, accounting for 57.5% and 42.5%, respectively; while the TIC patterns of lymph node lesions were predominantly type Ⅱ (96.6%). The difference in the TTP and the wash-in rate between the extranodal lesions and the lymph node lesions were both statistically significant ( P=0.000). Conclusion ·Extranodal lesions and lymph node lesions of KD both show isodensity on CT, and isointensity on T1WI and hyperintensity on T2WI in MRI. Extranodal lesions often show high ADC, TIC type Ⅰ or Ⅱ, and mostly heterogeneous enhancement; lymph node lesions often show low ADC, TIC type Ⅱ, and mostly homogenous enhancement.